Politics: Health Inequality and the NHS

Socioecomic position and health. Is it relevant to MS? #MSBlog #MSResearch

It is uncontroversial that socio-economic position (SEP) directly and indirectly effects quality of health and more and more quality of health provision. Class inequalities characterize over four fifths of officially recorded causes of death. There are pivotal and fundamental symptoms of relative poverty, which determine an array of environmental and biological factors that in turn increase rates of mortality, morbidity and generally poor health. 

It was shown in a 1958 study of British Males that birth weight corresponds to Housing inadequacy and financial difficulties. Indeed biology seems to determine SEP as well as SEP determining biology. A child’s height at the age of 7 has been shown to directly correlate to their chances of unemployment. 

So how does the NHS effect this matrix of determinant factors?

One can deduce two levels at which a national health system attempts to ameliorate the situations of a population’s lower classes. 

The first level is that of education, which is essentially a preventative measure. In reality this involves working against the default positioning of individuals facing an adverse SEP. With more quotidian and fundamental priorities education becomes seemingly remote from their day to day needs. However, a health system will try and educate on matters such as nutrition and lifestyle. It has to be said that the NHS has played a significant role in making smoking socially unacceptable and advocating legislation preventing smoking in public places. So within preventative measures there is legislation about education, literally barring unhealthy habits and there is also the dissemination of information, which aims at raising awareness of key issues. 

The second level at which a health system will try to improve the health of individuals facing adverse socio-economic positioning is the tailoring of the system to accommodate for the tendencies of those effected by their social class. Types of interaction from professionals working in the system will be designed in order to welcome individuals and encourage them to seek medical help. For instance - SEP is shown to correspond to the chances of domestic violence, also linked to alcohol and drug abuse, which is tied into SEP – work done to encourage women to seek help in the community when they are subjected to violence from their husband or partners. 

There are, however, ways in which health systems undermine themselves and accentuate class divisions in the operative places of health provision. 

Private prescribing in the NHS, a recent development and a product of the Health and Social Care Act (2012) not only creates a materially two tiered health system. It also re-enforces class in the hospital. By having medicines withheld for less well off patients they are implicitly but unmistakenly told that you are as good as your money. Further, the deeply entrenched class divisions of English Society are not simply about money. Class consciousness can manifest itself through deep insecurities about moral fibre and character. This undoubtedly has bearings on one’s health as stress and anxiety takes a physical toll. 

Many regard the notions of tough, well-versed middle class patients dominating the health system and rendering it two tiered as a myth. 

I do not think that they are a mythical people, and indeed represent the class divisions I am speaking of. 

Yet the problem is not localised incidents of class consciousness, where staff are more respondent to middle class patients, the real problem is more far reaching and generalised. There is a dramatic inequity between NHS services in the inner city and the countryside or suburb (click here). This highlights a typical capitalist contradiction where the stated aims of a State Service are subverted by powerful class interest ultimately working to undo the State of which they (class interest) are the deepest stakeholders.

Labels: ,